Author + information
- Received March 18, 2020
- Revision received May 11, 2020
- Accepted May 26, 2020
- Published online August 17, 2020.
- Sharonne N. Hayes, MDa,∗ (, )@SharonneHayes,
- Marysia S. Tweet, MDa,
- David Adlam, DPhilb,
- Esther S.H. Kim, MDc,
- Rajiv Gulati, MDa,
- Joel E. Price, MD, MPHd and
- Carl H. Rose, MDe
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDepartment of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
- cDivision of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
- dDivision of Cardiac Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- eDivision of Maternal and Fetal Medicine, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Sharonne N. Hayes, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
• SCAD is an important cause of MI, with unique associations and outcomes.
• Chest pain after SCAD is common; an initial noninvasive approach for stable patients is preferred.
• Evidence remains sparse for counseling about recurrence risk, physical activity, mental health, and reproductive issues.
• Prospective and collaborative research across centers and geography are needed to advance the science.
Over the past decade, spontaneous coronary artery dissection (SCAD) has emerged as an important cause of myocardial infarction, particularly among younger women. The pace of knowledge acquisition has been rapid, but ongoing challenges include accurately diagnosing SCAD and improving outcomes. Many SCAD patients experience substantial post-SCAD symptoms, recurrent SCAD, and psychosocial distress. Considerable uncertainty remains about optimal management of associated conditions, risk stratification and prevention of complications, recommendations for physical activity, reproductive planning, and the role of genetic evaluations. This review provides a clinical update on the diagnosis and management of patients with SCAD, including pregnancy-associated SCAD and pregnancy after SCAD, and highlight high-priority knowledge gaps that must be addressed.
Dr. Kim has served on the Advisory Board for Acer Therapeutics. Dr. Tweet’s work is supported by the Building Interdisciplinary Careers in Women’s Health (BIRCWH) NIH HD 65987. Dr. Adlam has received in-kind research support from AstraZeneca for SCAD genetics research and from Abbott Vascular to support a clinical research fellow involved in SCAD research; has received research funding from AstraZeneca for unrelated research; and has undertaken consultancy with General Electric Inc. to support general research funds. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received March 18, 2020.
- Revision received May 11, 2020.
- Accepted May 26, 2020.
- 2020 American College of Cardiology Foundation
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